Healthcare Provider Details

I. General information

NPI: 1316988025
Provider Name (Legal Business Name): WAYNE GENERAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 MATTHEW DR STE D
WAYNESBORO MS
39367-2567
US

IV. Provider business mailing address

951 MATTHEW DR STE D
WAYNESBORO MS
39367-2566
US

V. Phone/Fax

Practice location:
  • Phone: 601-671-2795
  • Fax: 601-735-4227
Mailing address:
  • Phone: 601-671-2795
  • Fax: 601-735-4227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KATHY D. WADDELL
Title or Position: CEO
Credential:
Phone: 601-735-7101